How to Use Condoms Correctly

Why use a condom? The types of condoms and how to use a condom. And what to do when your condom breaks.

By: Alan Copperman, MD

For many, condoms are the contraception of choice. Not only do these little latex miracles provide protection against pregnancy, they protect against many sexually transmitted diseases as well. Condoms have been used as birth control for hundreds of years. In days of old, the condom was shaped like a cap that fit over the head of the penis and was made of materials such as linen or sheepskin. Fortunately, their shapes, materials, and effectiveness have drastically improved since the days of sheepskin protection. Today, there are hundreds of styles and types to choose from.

Types of condoms You can choose condoms that are rippled, studded, dry, powdered, lubricated, tinted, transparent, treated with spermicide, or various combinations of any these types. In addition, condoms come in different sizes, which may or may not be marked on the package. The best way to find a favorite is to try them out. Some brands are longer, wider, or thicker than others, so you may need to try a few before you find one that is comfortable for you. Condoms usually come with three or twelve per package. They can cost as little as a quarter each and as much as $2.50. The lubricated condoms are more expensive, as are specialty condoms made from animal tissue or polyurethane. Polyurethane or plastic condoms should only be used if you are allergic to latex, as breakage rates may be higher in non-latex condoms. Make sure to read the labels on the more unusual condoms to determine whether they protect against pregnancy and sexually transmitted diseases. Also, pay attention to the expiration dates because condoms do lose their effectiveness with age. Condoms are available in drugstores, drug sections of larger stores, and family planning centers. They are also available on the Internet.

How to use a condom Condoms need to be used properly in order to provide protection against pregnancy and sexually transmitted diseases, and the most important thing to remember is to handle them carefully. They are easily broken and are ineffective when damaged. Condoms should be stored in a cool, dry place, and it's best not to stash them continually in a back pocket, wallet, or glove compartment.

Don't wait for the final moments to put it on... Don't wait for the final moments before orgasm to put on a condom. Pre-ejaculate can carry enough sperm to impregnate a woman. Men leak fluids from their penises before and after ejaculation, which can also carry enough germs to cause sexually transmitted infections. A fresh condom should be used each time a man is aroused. It's important that a partner be well lubricated before penetration with a condom. Not only does lubrication increase sensitivity and pleasure, it prevents condom tears. If you need to use lubricants, make sure that they are not oil-based, because oil can deteriorate latex and lead to breakage.

Putting it on In the heat of the moment, it's essential to use special care and restraint when opening the condom package. Condoms usually are packaged and sealed in aluminum foil or plastic, and the condom can break very easily as you open the package.

The condom should be placed over the tip of the erect penis, with extra space left at the tip. The condom is unrolled all the way to the base of the penis. Additional lubrication should be used if the condom is not already lubricated. After orgasm, when the man is pulling out of his partner's vagina, the condom needs to be held in place so that it doesn't come off. For maximal effectiveness, the penis should still be erect when it is removed from the vagina. Only when the penis is completely outside of the vagina should the condom be removed. It is also recommended that the penis be thoroughly washed after the condom comes off to ensure that no wayward sperm or germs make their way to the man's partner.

When bad things happen to good people Sometimes condoms break. In the event that this happens, it is important to consult a physician about obtaining protection against pregnancy (the morning-after pill) and against sexually transmitted diseases. The good news is that studies indicate that the condom breakage rate in the United States is less than two percent. If condoms are used consistently and correctly, the pregnancy rate should be less than five percent per year. Unfortunately, many couples don't use the condom each and every time and, in these cases, the pregnancy rate will be higher.

Anal sex It is important to remember that it is possible for either sex partner to become infected with HIV and other infections during anal sex. In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner also is at risk because HIV can enter through the urethra or through small cuts or open sores on the penis.

Having unprotected (without a condom) heterosexual or homosexual anal sex is considered to be very risky behavior. If people choose to have anal sex, they should always use a latex condom. While condoms work well most of the time, they are more likely to break during anal sex than during vaginal sex. A person should use a water-based lubricant in addition to the condom to reduce the chances of breakage.

Protection against sexually transmitted diseases The best way to protect yourself against contracting an STD while having sex is to properly use a latex condom. No other type of condom provides as much protection. There is not much research data to show how effective plastic and animal-tissue condoms are for protection against sexually transmitted infections. Some viruses, such as hepatitis B and HIV, may be small enough to pass through the pores of animal tissue. Latex condoms have been shown to provide protection against pelvic inflammatory disease (PID), gonorrhea, chlamydia, syphilis, human immunodeficiency virus, vaginitis caused by infections like trichomoniasis, and vaginitis caused by changes in the pH balance of the vagina that can be triggered by semen chancroid.

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Conclusion The condom is a good option for preventing pregnancy and sexually transmitted diseases. Although it is the most proven and effective barrier, the condom may not prevent all cases of pregnancy, nor all cases of HIV, and people should be extremely careful even during protected intercourse. That said, government-sponsored studies have shown that using a condom is 10,000 times safer than not using one in protecting against HIV. My recommendation to a couple using condoms is to use a latex condom in addition to other protection such as a diaphragm, cervical cap, contraceptive cream, foam, jelly, or even the birth control pill. This combination of contraception will provide you and your partner excellent protection from an unwanted pregnancy and/or sexually transmitted disease. Note, however, that spermicides containing nonoxynol-9 have been shown to be ineffective in preventing HIV transmission and may even increase the risk of infection. A recent WHO report advises against the use of condoms with nonoxynol-9, especially for women at high risk of HIV infection.

Last updated: 2/03.  Last reviewed: 10/05

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